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Teaching Non-Dermatologists — The Challenge Revisited

Nondermatologist hospital staff were not good at identifying and treating common skin diseases.

Researchers reviewed 271 consecutive inpatient dermatology consults that were requested over a 16-month period at the University of Iowa. Only 24% of the inpatient cases had been correctly diagnosed by the nondermatologists before referral, and changes in therapy followed the dermatology consult in more than 75% of cases. Common dermatological conditions prompted many referrals, and concordance between the dermatologist and the referring physician for such common disorders was rare: The consulting dermatologist confirmed only 18% of cases referred as dermatitis and only 26% of cases referred as dermatophyte infections.

Comment: This inpatient-based study can be compared with similar studies in the literature. When referring physicians know the diagnosis and begin the correct therapy, their patients do not end up in a study such as this. The study design shows the failures and not the successes of nondermatologists, and future inpatient studies should be designed to avoid this bias.

This caveat aside, one must consider why knowledge of the diagnosis and treatment of common skin diseases is so poorly disseminated. Either dermatology is very difficult to learn, or skin diseases are not taught correctly or extensively enough during medical school and residency. Do those who perform and learn well during their month-long dermatology rotation develop dermatological amnesia, or have we been teaching the astounding and rare diseases and not enough of the common conditions? The authors discuss time limitations in specialty subject education during residency. This study makes the point that nondermatologists need to learn not about rare and obscure conditions but how to identify and treat common diseases. All manpower surveys suggest that there will never be enough dermatologists to care for every skin problem. The growing trend toward full-time dermatology hospitalists may allow both better patient care and better education of nondermatologists.

— Lowell A. Goldsmith, MD, MPH

Published in Journal Watch Dermatology March 5, 2010

Citation(s):

Davila M et al. Epidemiology and outcomes of dermatology in-patient consultations in a Midwestern U.S. university hospital. Dermatol Online J 2010 Feb 15; 16:12. (http://dermatology.cdlib.org/1602/commentary/outcomes/sontheimer.html)

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• Derm teaching
  John L. Brown, 8 Mar 2010 2:09 PM EST
  Seems like dermatologists need to learn how to teach better. This assumes students know how to learn. Maybe some educational... [more]

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